{% include "includes/auth/janrain/signIn_traditional.html" with message='It looks like you are already verified. If you still have trouble signing in, you probably need a new confirmation link email.' %}

Fraud investigation at Rick Scott’s HCA led to the era of health care compliance

Twenty years ago, the job title “health care compliance officer” was rare and seldom seen.

Thank Gov. Rick Scott’s former company, HCA, for helping change that.

The huge fraud investigation into physician kickbacks and overbilling at HCA marked the launch of a more aggressive and activist inspector general function at the U.S. Department of Health and Human Services.

It meant the hospital companies had to institute corporate compliance programs that gave a specific officer responsibility for ensuring all federal and state regulations were followed, and fraud or abuse was investigated, addressed, and ultimately prevented.

To be effective compliance officers must have total support from their leadership and authority to carry out internal investigations, said Roy Snell, CEO of the Health Care Compliance Association, based in Minneapolis.

The passage of the Affordable Care Act has made compliance programs a requirement for health organizations like the Health Care District of Palm Beach County.

A good compliance officer is someone skilled in the arts of mediation, interviewing, educating and investigating, Snell said.

“There are some health systems where it is easier to implement a compliance program than others,” Snell said.

If everything works properly, an effective compliance officer can identify problems in an organization at an early stage, when they can be nipped in the bud before they become large problems, he said.

Tips from employees who feel safe from retaliation are a key to a successful program, he said.

“When whistleblowers are asked why they didn’t bring something forward, they say, ‘I have evidence that they have blown off other people before, so why do anything?'” Snell said. “Enron, Tyco, HealthSouth — all of them had people who knew something was wrong and wanted to do something. Unfortunately the request to identify and fix the problems fell on deaf ears.”

RoxAnne Harris, who started work as the Health Care District’s compliance officer in June, had worked in health care for over 20 years, working as compliance officer at Henry Ford Health System near Detroit since 2006. Her master’s degree came from Central Michigan University where she majored in health services administration. She was certified in health compliance and was a member of the Health Care Compliance Association and the American College of Health Care Executives.

The inquiry she had launched into the Health Care District’s information technology department was based on a series of tips she had received from people who had worked within, or had recently left the department, she said.

She had been warned that raising questions about a specific vendor contract or data security issues resulted in demotions or firings. After launching her own investigation, Harris was dismissed by the district’s CEO.

She contacted the district’s chairman, Jonathan Satter, and he pulled in the board’s attorney for a joint meeting. They agreed to reinstate Harris and bring in an outside law firm to investigate Harris’ dismissal and the allegations she had begun to investigate.

Satter said the Health Care District’s compliance officer is to report to the board, not the CEO.

Snell said that’s a best practice. He praised the district for hiring an outside firm to sort out its situation.

“Despite the frustration everybody is experiencing there, they are headed in the right direction,” Snell said. “Having an audit and compliance committee of the board is a brilliant move. Giving the compliance officer access to the board is a best practice.”

Compliance officers have a huge prevention role to play, he said.

“Most white collar criminals will tell you, ‘I wasn’t a crook when I started. I did this little thing and nobody stopped me, and I benefited by getting power and money. Then I did a little more and a little more, and pretty soon it caught the eye of someone.’

If there was a compliance officer, at the first instance they could go in and slap them on the wrist because it’s tiny,” Snell said. “But if they don’t, these things get so huge, everybody gets all wadded up and insulted and angry, and it’s just chaos.”